scholarly journals Report from the American Society of Transplantation Psychosocial Community of Practice Adherence Task Force: Real-world options for promoting adherence in adult recipients

2018 ◽  
Vol 32 (9) ◽  
pp. e13353 ◽  
Author(s):  
Larissa Myaskovsky ◽  
Michelle T. Jesse ◽  
Kristin Kuntz ◽  
Abbie D. Leino ◽  
John Devin Peipert ◽  
...  
Keyword(s):  
Community Of Practice ◽  
Real World ◽  
Task Force ◽  
American Society

scholarly journals Real-World Ethical Dilemmas in Laboratory Safety for Microbiology Under-Resourced and Outreach Teaching

2021 ◽  
Vol 12 ◽  
Author(s):  
Beverly L. Smith-Keiling
Keyword(s):  
Public Health ◽  
Real World ◽  
Task Force ◽  
Institutional Support ◽  
Ethical Challenges ◽  
Safety Standards ◽  
Ethical Frameworks ◽  
American Society ◽  
American Society For Microbiology ◽  
Authentic Learning Experiences

With modernization of safety standards for microbiology outreach teaching laboratories, ethical challenges arise in teaching microbiology for the public good without short-changing students in under-resourced situations, or when institutional support is subpar. Still, educators want students to engage using applied skills for inquiry, research-based microbial learning activities – safely. Following several United States microbial outbreaks, federal investigation traced sources back to teaching laboratories. Policy discussions ensued. The American Society for Microbiology (ASM) Task Force provides recommended but not mandated guidelines; however, guidelines are not amenable by all. Here, a real-world, ethical scenario of a university-level outreach microbiology laboratory course hosted at several locations provides context for under-resourced challenges in safety compliance. In this example of biomedical and public health ethical considerations, upper administration puts the onus on instructors to assure safe labs for their students and the general public. Temporarily hired instructors without curriculum or sufficient institutional support are put in precarious positions with often egregious practices to get the job done. This scenario is examined with different public health ethical frameworks and principles: non-maleficence, beneficence, health maximization, efficiency of policy regulations, respect for institutional and instructor autonomy, justice, and proportionality balancing stakeholder concerns. Sample curricular strategies are employed to mitigate these challenges. Taking a utilitarianism framework of the greatest good for the most benefit, this paper advocates for social justice supporting access to education as a moral duty. Administrations should ensure instructors are supported sufficiently to provide safe, authentic learning experiences. Solutions for under-resourced outreach teaching are needed for public trust.

scholarly journals How Is Geriatric Assessment Used in Clinical Practice for Older Adults With Cancer? A Survey of Cancer Providers by the American Society of Clinical Oncology

2020 ◽  
pp. OP.20.00442
Author(s):  
William Dale ◽  
Grant R. Williams ◽  
Amy R. MacKenzie ◽  
Enrique Soto-Perez-de-Celis ◽  
Ronald J. Maggiore ◽  
...  
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Online Survey ◽  
Task Force ◽  
Statistical Significance ◽  
Geriatric Oncology ◽  
Perceived Barriers ◽  
Patients With Cancer ◽  
Change Behavior ◽  
American Society

PURPOSE: For patients with cancer who are older than 65 years, the 2018 ASCO Guideline recommends geriatric assessment (GA) be performed. However, there are limited data on providers’ practices using GA. Therefore, ASCO’s Geriatric Oncology Task Force conducted a survey of providers to assess practice patterns and barriers to GA. METHODS: Cancer providers treating adult patients including those ≥ 65 years completed an online survey. Questions included those asking about awareness of ASCO’s Geriatric Oncology Guideline (2018), use of validated GA tools, and perceived barriers to using GA. Descriptive statistics and statistical comparisons between those aware of the Guideline and those who were not were conducted. Statistical significance was set at P < .05. RESULTS: Participants (N = 1,277) responded between April 5 and June 5, 2019. Approximately half (53%) reported awareness of the Guideline. The most frequently used GA tools, among those aware of the Guideline and those who were not, assessed functional status (69% v 50%; P < .001) and falls (62% v 45%; P < .001). Remaining tools were used < 50% of the time, including tools assessing weight loss, comorbidities, cognition, life expectancy, chemotherapy toxicity, mood, and noncancer mortality risk. GA use was two to four times higher among those who are aware of the Guideline. The most frequent barriers for those who reported being Guideline aware were lack of resources, specifically time (81.7%) and staff (77.0%). In comparison, those who were unaware of the Guideline most often reported the following barriers: lack of knowledge or training (78.4%), lack of awareness about tools (75.2%), and uncertainty about use of tools (75.0%). CONCLUSION: Among providers caring for older adults, 52% were aware of the ASCO Guideline. Some domains were assessed frequently (eg, function, falls), whereas other domains were assessed rarely (eg, mood, cognition). Guideline awareness was associated with two to four times increased use of GA and differing perceived barriers. Interventions facilitating Guideline-consistent implementation will require various strategies to change behavior.

scholarly journals NORMATIZAÇÃO PARA USO DO ÓXIDO NITROSO NA CLINICA ODONTOLÓGICA

DENS ◽  
2007 ◽  
Vol 15 (2) ◽  
Author(s):  
Grasielle KARPSTEIN ◽  
Wilson Kenji SHIROMA
Keyword(s):  
Nitrous Oxide ◽  
Practice Guidelines ◽  
Task Force ◽  
Sao Paulo ◽  
São Paulo ◽  
Very Old ◽  
Nitrous Oxide Oxygen ◽  
Sedation And Analgesia ◽  
American Society ◽  
New Look

Apesar do oxido nitroso ser usado há mais de cem anos no mundo inteiro, seu uso no Brasil ainda é restrito a poucos profissionais, a falta de informação causa receio por parte do profissional e também por parte dos pacientes, pois pela pouca divulgação ainda existem muitos mitos envolvendo essa técnica. Apenas há três anos o Conselho Federal de Odontologia baixou uma resolução estabelecendo normas para habilitação do Cirurgião Dentista na utilização de oxido nitroso em consultório na sedação consciente. Antes disso muitos cirurgiões dentistas se beneficiavam de lacunas na Legislação, utilizando-o, não raras vezes, de forma indiscriminada. O presente trabalho tem por objetivo trazer ao conhecimento dos acadêmicos e profissionais de odontologia as novas legislações para utilização do oxido nitroso, promovendo a discussão através de comparação da Resolução do CFO de 2004 e das normas que a secretaria de Saúde do Estado de São Paulo implementou em 2005.  Palavras-chave: Oxido Nitroso; Odontologia; Sedação Consciente  Referencias Bibliográficas 1. Brasil. Lei nº 5.081, de 24 de agosto de 1966. Regula o exercício da profissão odontológica. Diário Oficial da União, Poder Executivo, Brasília, DF, 26 ago. 1966.2. Ranali J. Óxido nitroso: por que usar. J Assoc Paul Cir Dent. 2001; 36(529):32-5.3. São Paulo (Estado). Secretaria de Estado da Saúde. Portaria CVS nº 11, de 03 de junho de 2003. Dispõe sobre proibição ao cirurgião-dentista em aplicar anestesia geral em consultório, ou qualquer tipo de analgesia, empregando fármacos com potencialidade de anestesia geral. Diário Oficial do Estado, Poder Executivo 2003a; 113(104): 23. Seção 1.4. São Paulo. Secretaria de Estado da Saúde. Portaria CVS nº 14, de 01 de agosto de 2003. Dispõe sobre a revogação da Portaria CVS 11, de 03/06/03 e cria grupo de trabalho para regulamentar o uso de anestésicos inalatórios em odontologia. Diário Oficial do Estado, Poder Executivo  2003b; 113(144): 23. Seção 1.5. Moura, L. C. L;  A utilização da sedação consciente com oxido nitroso/oxigenio (N20/02) em Odontologia. 20056. AMERICAN SOCIETY OF ANESTHESIOLOGY TASK FORCE: Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 96(4):1004, 2002.7. ANDRADE, E.D. (1999). Terapêutica medicamentosa em Odontologia. 1ªed, São Paulo, Artes Médicas.8. ANDRADE, E.D. & RANALI, J. (2004). Emergências Médicas em Odontologia. 2ªed, São Paulo, Artes Médicas.9. MALAMED, S. F. & CLARK, M. (2003). Nitrous Oxide-Oxygen: A new look at a very old technique. Journal of the California Dental Association, 31(5):397-403.10. RANALI, J., RAMACCIATO, J.C., MOTTA, R.H.L. (2004). Biossegurança na sedação inalatória com óxido nitroso e oxigênio. Revista da Associação Paulista de Cirurgiões Dentistas, 58(5): 374-378 

Practice Guidelines for the Prevention, Detection, and Management of Respiratory Depression Associated with Neuraxial Opioid Administration

2016 ◽  
Vol 124 (3) ◽  
pp. 535-552 ◽  
Keyword(s):  
Respiratory Depression ◽  
Regional Anesthesia ◽  
Practice Guidelines ◽  
Task Force ◽  
Digital Content ◽  
Pain Medicine ◽  
Practice Parameters ◽  
Opioid Administration ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract The American Society of Anesthesiologists Committee on Standards and Practice Parameters and the Task Force on Neuraxial Opioids and the American Society of Regional Anesthesia and Pain Medicine present an updated report of the Practice Guidelines for the Prevention, Detection, and Management of Respiratory Depression Associated with Neuraxial Opioid Administration. Supplemental Digital Content is available in the text.

Practice Guidelines for Obstetric Anesthesia

2016 ◽  
Vol 124 (2) ◽  
pp. 270-300 ◽  
Keyword(s):  
Practice Guidelines ◽  
Task Force ◽  
Obstetric Anesthesia ◽  
Supplemental Digital Content ◽  
Digital Content ◽  
Practice Parameters ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract The American Society of Anesthesiologists Committee on Standards and Practice Parameters and the Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology present an updated report of the Practice Guidelines for Obstetric Anesthesia. Supplemental Digital Content is available in the text.

scholarly journals Discordant American Society of Anesthesiologists Physical Status Scoring between Anesthesiologists and Surgeons Is Correlated With Adverse Patient Outcomes: A Retrospective Cohort Study of 46284 Elective Surgical Patients

2021 ◽  
Author(s):  
Charlene Xian Wen Kwa ◽  
Jiaqian Cui ◽  
Daniel Yan Zheng Lim ◽  
Yilin Eileen Sim ◽  
Yuhe Ke ◽  
...  
Keyword(s):  
Cohort Study ◽  
Patient Outcomes ◽  
Real World ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Clinical Factors ◽  
Physical Status ◽  
Asa Score ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract BackgroundThe American Society of Anesthesiologists Physical Status Classification (ASA) score is used for communication of patient health status, risk scoring, benchmarking and financial claims. Prior studies using hypothetical scenarios have shown poor concordance of ASA scoring among healthcare providers. However, there is a paucity of concordance studies using real-world data, as well as studies of clinical factors or patient outcomes associated with discordant scoring. The study aims to assess real-world ASA score concordance between surgeons and anesthesiologists, factors surrounding discordance and its impact on patient outcomes. MethodsThis retrospective cohort study was conducted in a tertiary academic medical center on 46284 consecutive patients undergoing elective surgery between January 2017 and December 2019. ASA scores entered by surgeons and anesthesiologists, patient demographics, and post-operative outcomes were collected. We assessed the concordance of preoperative ASA scoring between surgeons and anesthesiologists, clinical factors associated with score discordance, the impact of score discordance on clinically important outcomes, and the discriminative ability of the two scores for 30-day mortality, 1-year mortality, and intensive care unit (ICU) admission. Statistical tests used included Cohen’s weighted 𝜅 score, chi-square test, t-test, unadjusted odds ratios and logistic regression models. ResultsThe ASA score showed moderate concordance (weighted Cohen’s 𝜅 0.53) between surgeons and anesthesiologists. 15098 patients (32.6%) had discordant scores, of which 11985 (79.4%) were scored lower by surgeons. We found significant associations between discordant scores and anesthesiologist-assessed comorbidities, patient age and race. Patients with discordant scores had a higher risk of 30-day mortality (odds ratio 2.00, 95% confidence interval [CI] = 1.52-2.62, p<0.0001), 1-year mortality (odds ratio 1.53, 95% CI = 1.38-1.69, p < 0.0001), and ICU admission >24 hours (odds ratio 1.69, 95% CI = 1.47-1.94, p< 0.0001), and stratified analyses showed a trend towards higher risk when the surgeons’ ASA score was lower. ConclusionsThere is moderate concordance between surgeons and anesthesiologists in assigning the ASA classification. Discordant ASA scores are associated with adverse patient outcomes. Hence, there is a need for improved standardization of ASA scoring and cross-specialty review in ASA-discordant cases.

Practice Advisory on Anesthetic Care for Magnetic Resonance Imaging

2015 ◽  
Vol 122 (3) ◽  
pp. 495-520 ◽  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Task Force ◽  
Digital Content ◽  
Resonance Imaging ◽  
Anesthetic Care ◽  
Practice Parameters ◽  
Practice Advisory ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract The American Society of Anesthesiologists Committee on Standards and Practice Parameters and the Task Force on Anesthetic Care for Magnetic Resonance Imaging presents an updated report of the Practice Advisory on Anesthetic Care for Magnetic Resonance Imaging. Supplemental Digital Content is available in the text.

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